Proximal versus distal splenic artery embolization prior to splenectomy for hypersplenism

Abstract

Purpose:(1) To assess the efficacy of empiric gastroduodenal artery and left gastric artery embolization in reducing recurrent hemorrhage compared to image-guided targeted embolization.(2) To assess the efficacy of embolization of the GDA in reducing recurrent hemorrhage compared to the LGA. Materials and Methods:A single-institution retrospective study was done by reviewing medical records of patients who had catheter angiography for major upper gastrointestinal bleeding (UGIB) refractory to endoscopic intervention from June 2009 to April 2013 (n ¼ 53). Groups were assigned based on either targeted or empiric embolization. Technical success was defined as absence of contrast extravasation by the vessel of interest and collateral circulation. Clinical success was defined as a combination of technical success with an improvement in hemoglobin, no evidence of further hemorrhage after embolization, and no requirement for further intervention in the successive four weeks.Results: The technical and clinical success rates for targeted and empiric embolization groups were, respectively, 100 vs. 100%, and 88 vs. 93%. There was no statistical significance in the recurrent hemorrhage rate, reintervention rate, or 30 day mortality between targeted and empiric embolization groups.The technical and clinical success rates for embolization of the GDA and LGA were, respectively, 100 vs. 100%, and 81 vs. 94%. There was no statistical significance in the recurrent hemorrhage rate, reintervention rate, or 30 day mortality between GDA and LGA embolization. Conclusion:In patients with upper gastrointestinal bleeding refractory to endoscopic interventions, empiric embolization should be considered as the first-line management to control the hemorrhage. Empiric embolization of the GDA or LGA in patients with major UGIB refractory to endoscopic treatment appears to be a safe and effective treatment, with low reintervention rates and good clinical outcomes that are comparable to that of patients where the site of hemorrhage is localized and embolized under the guidance of imaging. Embolization of the GDA and LGA also demonstrate similar outcomes with regards to low rebleeding rates, low reintervention rates, and good clinical outcomes.